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. 2020 May 29;217:108487. doi: 10.1016/j.clim.2020.108487

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© 2020 Elsevier Inc. All rights reserved.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Fig. 1 — Ileal and splenic infarctions in a 72-year-old Italian male patient affected by COVID-19 and submitted to rescue surgery after 18 days from SARS-CoV-2 molecular detection through nasopharyngeal swab [IL-6 sequential dosages by serum immune assays: from 154.03 ρg/ml - day 1 to 2656.46 ρg/ml - day 18]: on sagittal abdomen computed tomography (CT) scan with contrast medium, an aortic thrombus (A, red arrow) and one at the celiac tripod (A, yellow arrow) are clearly visible, while on axial abdomen CT scans a large ischemic intestinal loop shows pneumatosis intestinalis (A, green arrow) and only a central portion of healthy spleen (A, blue arrow) remains vascularized by the splenic artery; grossly, the transition zone between the upper residual spleen parenchyma and the lower discolored infarcted area is captured (B); on histopathology, the splenic artery appears thrombosed and involved by vasculitis (C, hematoxylin & eosin, 2.5× objective); at higher magnification (D, hematoxylin & eosin, 10× objective), the inflammation is arranged around (periarteritis) and inside (panarteritis) the vascular wall; in the cytological details, neutrophils and karyorrhexis are well noticeable, a classical histological picture for LCV (E, hematoxylin & eosin, 60× objective), while Toluidine blue stain highlights the purple granules of a mast cell in the degranulation phase close to polymorphonuclear neutrophils (F, 100× objective); phosphotungstic acid hematoxylin reveals blue spots of fibrinoid necrosis in the full thickness of the splenic artery wall (G, 40× objective), more concentrated just below the internal elastic membrane in the innermost part of tunica media (H, 100× objective); immunofluorescence confirms the presence of green-brightened immune complexes, mainly consisting of IgG (I, anti-human polyclonal IgG/FITC, 100× objective), but also of IgM (J, anti-human polyclonal IgM/FITC, 100× objective) and IgA (K, anti-human polyclonal IgA/FITC, 100× objective), together with C3 complement deposits (L, anti-human polyclonal C3 complement/FITC, 100× objective). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).